DRC reports more suspected Ebola cases in Iboko

The Democratic Republic of Congo's health ministry yesterday and today ruled out some suspected cases based on lab tests and confirmed 2 more in the remote Iboko outbreak location, dropping the outbreak total to 50 cases, including 37 confirmed and 13 probable, with no suspected cases. No new deaths were reported, keeping that total at 25.

The health ministry said yesterday that its communication team had awareness sessions with 200 cyclists and motorcycle taxis drivers in Mbandaka, the provincial capital, to teach them about precautionary measures to prevent Ebola infection, given that the drivers are frequently used to take sick patients to health centers, posing hazards to drivers and other passengers.

During the meetings, health officials identified five drivers who had been in contact with confirmed Ebola case-patients. The drivers are now being monitored and have agreed to be vaccinated.

Since ring vaccination began in the DRC on May 21, as of yesterday, 682 people have now been immunized with VSV-EBOV—499 in Mbandaka, 113 in Bikoro, and 70 in Iboko.

In another development, the ministry said several schools in the Iboko Health Zone have temporarily suspended classes to protect children. Health ministry teams have organized educational sessions on Ebola aimed at local primary schools and are meeting with teachers and parents.May 30 DRC health ministry report May 31 DRC health ministry report

Officials: 15 dead in India's Nipah outbreak

Fifteen people are dead after contracting Nipha virus in India's Kerala state, according to the latest updates from health officials in the region.

Medical officer V. Jayashree told Reuters that totals in the outbreak now stand at 17 cases, and the 2 most recent patients likely contracted the disease from a medical college. So far, the disease has stayed in Kerala state.

According to an update today from the World Health Organization (WHO), as of May 28, officials are tracking 16 suspected cases identified through contact tracing. More than 700 additional people, including health care workers, are under observation.

"In the current outbreak, acute respiratory distress syndrome and encephalitis have been observed," the WHO said. "This is the first NiV [Nika virus] outbreak reported in Kerala State and third NiV outbreak known to have occurred in India, with the most recent outbreak reported in 2007."

Nipah can be spread through contact with bats, pigs, and infected bodily fluids.May 31 ReutersstoryMay 31 WHO update

Public health emergency guidelines leave room for improvement

A study yesterday in PLoS One reviews emergency guidelines produced by the WHO during four recent major public health events and finds them lacking.

Experts from the WHO, Spain, and Canada assessed 175 information products (including 87 guidelines) created during the 2009 H1N1 pandemic, H7N9 avian flu and MERS outbreaks in 2013, and Ebola in West Africa from 2014 to 2016.

All four events required significant responses from the WHO, and reviewers evaluated all written materials created by the WHO, excluding testimonials, media releases, situation reports, and meeting reports. The materials were reviewed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, a widely used quality appraisal tool.

Ebola had the most products, with 84, followed by H1N1, MERS, and avian flu. Reviewers said even within a public health emergency, WHO information was scattered, lacking cohesive branding and consistency.

The reviewers said guidelines were rarely peer reviewed, and only 3 documents included in the analysis were reviewed by the WHO's Guidelines Review Committee, which was developed more than a decade ago to ensure "that each WHO guideline is evidence-based and meets the highest international standards."

"Information products issued by WHO during four recent infectious disease epidemics were difficult to find, were often published at long intervals after outbreaks were graded, and demonstrated variable adherence to WHO publication and reporting requirements," the authors said. "Few guidelines met international standards for the development and presentation of trustworthy and usable guidelines, as assessed with tools designed for standard (non-emergency) guidelines."May 30 PLoS Onestudy

More avian flu outbreaks from different strains reported in 4 countries

Four countries reported recent avian influenza detections involving different strains, all part of ongoing sporadic activity in the different locations, according to notifications posted over the past few days by the World Organization for Animal Health (OIE).

Three reported highly pathogenic outbreaks. South Africa today said H5N8 was found in three different sea bird species found dead near the city of Kouga in Eastern Cape province on the southern coast of the country. The event began on May 3 affecting a Cape cormorant, a swift tern, and an African black oystercatcher. South Africa has been reporting sporadic H5N8 detections in wild birds since the summer of 2017.

Elsewhere, Sweden said lab tests on a white-tailed eagle found dead on May 6 in Kalmar County in the southeast were positive for H5N6. The country has been reporting similar detections since March.

In Taiwan, health officials reported three more H5N2 outbreaks in poultry. The outbreaks began on May 14, affecting native chickens at a slaughterhouse in Taipei City, native chickens at a farm in Yunlin County, and meat geese at a farm in Tainan City. Between the three locations, the virus killed 1,637 of 18,867 birds. Taiwan has been battling H5N2 along with a few other avian flu strains in poultry since early 2015.May 31 OIE report on H5N8 in South Africa May 25 OIE report on H5N6 in Sweden May 30 OIE report on H5N2 in Taiwan

In low-pathogenic developments, the Dominican Republic reported an H5N2 outbreak at a layer farm in La Vega province in the central part of the country. The event began on May 2, killing 46 of 22,965 susceptible birds. The remaining birds were culled to curb the spread of the virus. The country reported similar outbreaks in February, with La Vega being one of two provinces affected at that time.May 29 OIE report on H5N2 in the Dominican Republic